Hospital esophagectomy volume and postoperative length of stay: A systematic review and meta-analysis

Background: Much attention in the volume-outcomes literature has focused on the empirical impact of surgical caseload on outcomes. However, relevant studies on the association between surgical volume and variables that potentially contribute to healthcare costs are limited. The objective of this study was to systematically elucidate a contemporary analysis of the empirical relationship between hospital esophagectomy volume and postoperative length of stay, a cost-related outcome. Data sources: OvidSP, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and OpenGrey were searched for relevant articles published from 2000 to 2016. Results: High hospital esophagectomy volume was associated with reduced postoperative length of stay (mean: 3 days; 95% CI: 2.8, 3.2) and risk of prolonged length of stay (RR: 0.80, 95% CI: 0.74, 0.87) in a dose-response fashion. Conclusions: Complex surgeries performed at high surgical volume centers may be associated with overall decrease in postoperative length of stay, a cost-related outcome. (C) 2017 Elsevier Inc. All rights reserved.